Stephania Bell: Jose Guillen

Jed Lowrie, Mark Teixeira battling wrist injuries

April, 14, 2009
My, oh my, what a week it has been. Emotions have run the gamut this week in baseball.

The tragic loss of young Nick Adenhart in Los Angeles had everyone reflecting on the importance of living the dream and doing what you love. The triumphant return of Chris Carpenter to the mound for the Cardinals proved that you can come back after almost a two-year hiatus with hard work, dedication and belief that you still have it.

The sad news of Harry Kalas' passing reminds us that there are numerous folks behind the scenes whose contributions help to define the sport. Many of those folks are never seen (or heard) by the public, especially when it comes to those responsible for the medical well-being of the athletes. When it comes to keeping an athlete on the field, there are numerous doctors, athletic trainers, physical therapists and others who play a huge role but remain largely out of public view.

And on that note, here are the players I'm looking at this week in the world of injuries:

Jed Lowrie
AP Photo/Elise AmendolaJed Lowrie's owners should brace for an "extended absence" from their young shortstop.
Jed Lowrie, SS, Red Sox: It was no secret that Lowrie was struggling at the plate; we could see he was a mere 1-for-18 with eight strikeouts this season. The secret apparently was that Lowrie's wrist was bothering him all along, according to The Boston Globe. When Lowrie finally made it known to the medical staff that his left wrist was giving him trouble, the Red Sox quickly placed him on the disabled list. The Globe reports that this is the same wrist that gave Lowrie trouble last year, and an MRI at the end of the season revealed a small nondisplaced fracture (meaning the bony parts are in alignment, not fragmented). Symptoms in the same area, however, are never a good sign, as it could suggest that the fracture has not fully healed.

In fact, comments Lowrie made about his wrist in February seem somewhat foreboding in retrospect. In a report by The Providence Journal, Lowrie explained the decision to rest his wrist for a month in the offseason. "We decided not to do surgery just because there wasn't enough time. I probably wouldn't have been ready for spring training if I [had] had the surgery."

Lowrie went on to explain to the Journal exactly how the injury affected him at the plate. "From the left side, and I'm not one to make excuses, it really hindered my ability to swing with any sort of power. My wrist was just not strong enough to keep the barrel above the ball."

Lowrie has been returned to Boston for further testing, and a true timetable will become more apparent once the results are known. The concern here is that after an offseason of rest, Lowrie is experiencing similar pain, and there can be no doubt that it is affecting him at the plate. If several months of rest did not alleviate the problem, it's unlikely 15 days will do so, either. The question becomes what structure or structures actually are causing the symptoms, and what is the appropriate course of treatment? A non-union fracture might require surgery, but inflammation of soft tissues could be addressed with rest, bracing and anti-inflammatories. Until the condition is further explained, this remains speculative, but fans should prepare for the prospect of an extended absence from Lowrie.

Of course, the Red Sox are further incapacitated at shortstop because Julio Lugo remains on the DL as he recovers from meniscal surgery. Lugo underwent surgery on his right knee during spring training and is progressing well, but he's still likely another couple of weeks from rejoining his team.

Mark Teixeira, 1B, Yankees: Speaking of sore wrists, Teixeira has been dealing with soreness in his left wrist for several days now. Fortunately for the Yankees, Teixeira's ailment does not appear to be serious, and the hope is that rest will allow it to calm down. He has been diagnosed with tendinitis in his left wrist, apparently aggravated by batting right-handed. Teixeira suspected he initially strained his wrist when diving for a ball last week, but the inflammation then appeared to be limiting his swing.

In an effort to prevent it from worsening, the Yankees rested him for a few games, but he is expected to rejoin the lineup Tuesday. A recent MRI confirmed the absence of any major structural injury, and Teixeira told that the stronger anti-inflammatories he has been taking recently have him feeling much better. Assuming he makes a successful return this week, this does not appear to have the makings of a significant injury.

Ichiro Suzuki, OF, Mariners: Ichiro has been recovering nicely from the bleeding ulcer that sent him to the DL to start the season. Last week, we said there was reason to believe Suzuki would return as soon as he was eligible to be activated off the DL, and it appears this will indeed be the case. He indicated he will be in the lineup when his team takes the field Wednesday, and the team no doubt will be happy to have him back.

Ichiro did not appear to have missed a beat when he made his first extended spring training start, going 7-for-10 in his first outing and appearing none the worse for wear afterward.

The good news for Ichiro and for fantasy owners is that this ulcer should not present a recurring problem. Ichiro's rapid response to treatment -- coupled with the fact that these conditions can be medically managed very effectively -- suggests a low likelihood that this will interfere with the remainder of his season.

Jesse Litsch, SP, Blue Jays: I don't like the way this looks. It began with a poor start a week ago and some forearm soreness. Then there was a second poor outing Monday, and by the fourth inning, it was clear something was wrong. Litsch signaled as much, and after a visit with the Jays' athletic trainer, he left the game holding his right arm against his body. The Toronto Star reports that the team is temporarily calling this an elbow strain, and Litsch will undergo an MRI.

This is a recipe for bad news. First of all, he followed a decent spring with two poor starts. And in addition to decreased velocity and trouble with control, Litsch also had discomfort, making this appear more serious. The pain was bad enough to force him to exit early, and the instinctive supporting of his arm by his side is not an encouraging sign. Clearly, the test results will help determine the next steps for Litsch, but brace for a likely shutdown from throwing to rest the arm.

Dewayne Wise, OF, White Sox: Even his manager, Ozzie Guillen, gave him credit for saving the game Monday. If you saw Wise's amazing play in the outfield, you probably also saw him cringing in pain afterward. As Wise extended his arm to steal a hit from Ramon Santiago, potentially saving three runs, he rolled awkwardly onto his right shoulder, separating it. An acromioclavicular (AC) joint separation, as this is called, is a sprain of the ligaments that stabilize the clavicle, or collarbone, with the acromion, the bony tip of the shoulder blade. That AC junction forms the outermost point of the shoulder, and injury to the ligaments there makes it painful to move the arm, particularly across the body or overhead.

Wise has been placed on the DL with what the Chicago Tribune is reporting as a Grade III (complete) separation, and according to the White Sox's Web site, Wise is expected to miss anywhere from six to eight weeks while the ligaments heal. He will initially be placed in a sling to support the painful shoulder and will then work on regaining his range of motion and strength. The most challenging element will be regaining the strength to make a long throw from the outfield. This is not typically an injury that requires surgery, although it can come to that for some "overhead" athletes, particularly if they continue to experience weakness or discomfort as they return to throwing.

Although the team certainly expects to have Wise return to the lineup this season, his rehab process bears watching to see how he progresses once he is allowed to resume throwing.

Brian Moehler, SP, Astros: He certainly didn't have a great start to the season, yielding seven runs on eight hits in his first outing. And the news only gets worse from there, as it appears Moehler has an injury to contend with, as well. After Moehler left Monday's game early in another forgettable start, the team indicated that he will undergo an MRI on his right knee, which apparently has been bothering him since spring training.

The injury has been described thus far as a sprain on the Astros' official Web site, although there has been no indication of a specific initial injury. Moehler did indicate, though, that the knee had been bothering him "off and on" for a few weeks. Moehler is a right-handed pitcher, so this injury is affecting his push-off leg. If there is any instability, it certainly would affect the power of his delivery. With an ERA of 27.00 in two starts, it certainly seems as though something isn't right, and this could very well be the explanation.

Until the test results are in, it's unclear what his potential timetable to return will be. As of now, the Astros have not even indicated whether Moehler will make his next start.

Milton Bradley, OF, Cubs: Bradley is expected to miss several days because of a groin strain, and the Cubs have to hope it won't be longer than that. Bradley is no stranger to soft-tissue injuries, having experienced his share of muscle strains, not to mention a torn ACL and partially torn patellar tendon, over the past few seasons. And, of course, he is not getting any younger.

Although the groin strain is considered mild, this is one of those injuries that can rapidly turn into something more serious if a player pushes it too soon. It's possible that this could turn into a trip to the DL if Bradley's symptoms show signs of lingering. That's worth keeping in mind if he's on your fantasy roster.

On the mend

Alex Rodriguez
AP Photo/Reinhold MatayAlex Rodriguez is rehabbing hard, and now we can witness it.
There has been an Alex Rodriguez sighting in Tampa. Now that he is removed from the protective enclave of Vail, Colo., where he spent his first few weeks rehabilitating his surgical hip, we can see Rodriguez doing some of his workout drills. And he reportedly looks good. He appears physically fit and happy, both of which are important components of a successful return. But before we get too excited, it's important to remember that he is still doing limited baseball activity.

The New York Times reports that, so far, Rodriguez has taken swings off a tee and from light toss, fielded some routine ground balls and done some light running. The real point of interest will be when he is ready to return to game playing. Rodriguez says he feels the next seven to 10 days are very important as he enters the next phase of his rehab. Manager Joe Girardi has been careful to say that he maintains the expectation of a mid-May return for Rodriguez and that he does not want to push unnecessarily. So far, the steps A-Rod is taking suggest he could meet the target, but his biggest tests on the hip -- power hitting, hard running, diving and sliding -- have yet to take place. It's still a lot to accomplish in a short time. We will be watching closely ... especially now that he's in Tampa and we can actually do so.

Just last week, I placed the Angels' Kelvim Escobar in the "good news" department. Since then, the team has talked about shutting down his throwing for a few days. I'm not throwing in the towel here just yet. Remember, Escobar was well ahead of schedule in his rehab after labral surgery. His soreness is in the front of the shoulder (less worrisome), and his activity has simply been scaled back to ensure that this does not turn into something more serious. Escobar still could return in May, and even that would still place him ahead of his original timetable.

Meanwhile, Braves pitcher Tom Glavine is paying a visit to the one and only Dr. James Andrews this week. Glavine, who is coming off surgeries on his elbow and his shoulder, experienced discomfort in his shoulder this past weekend that forced an early exit from a minor league rehab start. Glavine is not speculating about his future, saying only that he's "remaining optimistic that [he] just popped some scar tissue," according to the Braves' Web site. At 43, it's a lot to hope for, but it would be nice for Glavine to end his career on his terms. This is not exactly confidence-inspiring, but I would not call him finished just yet.

And finally, Royals outfielder Jose Guillen was placed on the 15-day DL Friday because of a partially torn hip flexor. The concern with this 32-year-old's injury is whether it will turn into multiple DL stints or whether Guillen can really return as expected. There are a couple of reasons to be optimistic. First, according to general manager Dayton Moore, "Jose wanted to play through it, but this is the right thing to do for him and the team." If Guillen thought he could play through it, it could not have been too awful. Second, Moore indicated that the team was operating from a position of being proactive when he said that the team did not want to risk losing Guillen for months or, even worse, to surgery should the outfielder continue to play in cold weather early in the season, and perhaps worsen the injury. In other words, they'll take a more conservative approach and lose a few days now instead of weeks or months in the meat of the season. By the sound of it, the team is viewing this episode as minor.

Oswalt looking better

July, 28, 2008

Despite a few days' reprieve with the All-Star break, the second half of the season is not lacking for injury content. Several players have come back from injury since the second half of the season started (David Ortiz, Alfonso Soriano), a few are still on the mend (Kerry Wood) and new injuries continue to crop up. We take a look at some of the key fantasy players dealing with injury below, and welcome back another Tommy John graduate this week.

[+] EnlargeRoy Oswalt
Mitchell Layton/Getty ImagesOswalt will try to make a strong finishing kick now that he's well rested.
Roy Oswalt, P, Houston Astros: Oswalt is scheduled to return to the mound Monday against the Cincinnati Reds after two uneventful bullpen sessions last week. Oswalt has been sidelined with what the team has been calling a hip abductor strain, although a recent MRI also confirmed a disk problem in his lower back. The two problems certainly appear to be connected, since Oswalt told the Houston Chronicle several weeks ago that a spinal injection left him feeling "great." In fact, it is difficult to completely dissociate the two problems since disk injury in the lower back often contributes, either directly or indirectly, to hip problems. The abductor muscles help to move the hip laterally, and perhaps more importantly in Oswalt's case since the involved leg is his landing leg, contribute to stability of the pelvis. I said in a prior blog that I would not be surprised to see Oswalt end up on the disabled list due to the complex nature of his injury. He has no doubt benefited from the rest and rehab afforded him during his stint on the disabled list, and the good news is that he has been able to throw off a mound recently without pain. His first bullpen session was Wednesday, at which point the Astros' official site reported that Oswalt threw at approximately 75-80 percent of full strength. On Friday he upped his intensity but capped the pitches at about 25-30 according to the Houston Chronicle. He also faced a pair of teammates in an effort to prepare for Monday's outing. Manager Cecil Cooper told the Chronicle that he expects Oswalt to throw about 90 pitches, which may be optimistic for his first outing. The concern with the type of problem that Oswalt has is recurrence. This is not a ligament sprain waiting to heal with a fairly definitive timetable. This is a more complex interplay of disk dysfunction, which tends to be chronic, and a related muscle group (hip abductors) involved in a very repetitive motion (pitching). If all goes well, it may still take Oswalt some time to build up the endurance to go deep into a game. Fantasy owners should be cautious.

Aaron Harang, P, Cincinnati Reds: As Oswalt prepares to face the Reds, the Reds are hoping for the return of one of their aces in the not too distant future. Harang, who has been on the disabled list with forearm stiffness, was able to throw from a distance of 70 feet Tuesday and surprised himself with how good he felt. On the Reds' official Web site, Harang acknowledged feeling tentative at the start of the session as he wanted to make sure that there "wasn't something there," but as the arm continued to respond, Harang said he was able to let go a little. He is scheduled to throw off a mound Monday, which will further test the forearm as he will be forced to throw harder. If the session goes well, the Reds should be able to lay out a better timetable for Harang's return, but at this point it would appear that it could happen within a couple of weeks. The fact that Harang's issues appear to have been primarily muscular, as opposed to ligamentous or a joint injury in the elbow, bodes well for his successful return.

Jose Guillen
Rick Scuteri/US PresswireAfter a mostly healthy 2007, the nagging injuries are back for Guillen.
Jose Guillen, OF, Kansas City Royals: Guillen made a decision to remain in Saturday's game after reportedly feeling his groin "snap" in the fifth inning, and came to regret it, according to the Kansas City Star. Guillen acknowledged that he couldn't even walk right after the incident and seemed to be questioning aloud why he didn't put an end to his misery sooner. Guillen was not active for Sunday's game and although he is slated to play Monday, it would not be a surprise if his status changes since Guillen himself told the Star that he pulled the groin "worse than the first time this season." Keep in mind that Guillen has also missed games in July due to back spasms and in June due to a sore hip. The musculoskeletal issues seem to be catching up with Guillen and if he cannot play effectively, it would not be a surprise if the team grants him some additional rest, despite the fact that the Royals could use his services early this week as they face the Oakland A's. While it appears that the latest setback is not particularly serious, these things can have a cumulative impact. Keep a close eye on Guillen's status this week.

Brian McCann, C, Atlanta Braves: The Braves have certainly faced their share of injury woes this season and it does not appear to be letting up. McCann took on a tough collision at the plate Sunday with Phillies outfielder Shane Victorino and the end result was a concussion. He was able to walk off the field under his own power and X-rays were negative, but it is impossible to determine with any certainty how much time he will miss. Given the long absence of the Toronto Blue Jays' Aaron Hill, out since late May after a concussion, and the persistent and recurrent symptoms that the New York Mets' Ryan Church has faced this season, one thing is certain: It is impossible to truly determine the severity of a concussion at the time of injury. Loss of consciousness, while serious, is not necessarily an indicator of concussion severity. The main thing for McCann at this point is to rest until all symptoms clear. He will then be allowed to progressively resume activity and he will be monitored to see if any symptoms, such as dizziness, nausea or headache, return with that activity. McCann will not be in the Monday lineup.

And in the good news department

We always like to end on a high note, so this week's good news is that Chris Carpenter returns to the lineup for the St. Louis Cardinals. Carpenter, who has been out since 2007 following Tommy John surgery, is expected to start Wednesday for the Cardinals. This would be his first start since Opening Day last year. His recent rehab starts are encouraging in that he has showed progressively reasonable command, something pitchers often struggle with early in their return from this procedure. Although he will no doubt continue to improve during his first few outings, there is reason to believe that Carpenter can contribute immediately. For fantasy owners, don't set unreasonable expectations, but he may be a good value pitcher, especially by late August when he will likely go deeper into games.